Published: Sunday, December 8, 2013 at 6:30 a.m.

Last Modified: Saturday, December 7, 2013 at 9:02 p.m.

On Thanksgiving morning, more than 1,000 runners put on long-sleeved shirts, braved the chill and competed in the annual 5K Turkey Trot.

Hours later, many of those athletes traded their race-day bibs for dinner bibs and trotted toward a dining room table.

Exercise, then eat. Seems like a fair trade. And for that one day, perhaps it was — provided the pumpkin pie slices were of defensible dimensions.

But statistics suggest many Marion County residents are eating more than exercising on the 364 other days of the year. And while talking about weight management during the holiday season might be a bah-humbug kind of thing to do, the timing actually is just right. Because in 2014, the medical profession will be zeroing in on patients' weight like never before.

In mid-November, national medical experts issued a new, headline-grabbing set of guidelines concerning heart health and proper use of cholesterol-lowering statins.

The general idea was that patients' heart risk should be assessed in a more broad fashion, not just by their cholesterol numbers, and that medical providers should be more aggressive in getting patients on medicinal regimens.

Less noticed, but equally significant, was a related set of guidelines for combating and addressing obesity. In essence, the rules call for a more aggressive approach to identifying and addressing weight problems.

In other words, at your next annual checkup in 2014, the doctor is less likely to say, “Hey, you could afford to lose some weight,” and leave it at that.

Rather, doctors are now asked to, at least once a year, calculate their patients' body-mass index (BMI) and measure their waists. If appropriate, doctors are advised to develop a weight-loss plan that includes dietary and exercise components and, perhaps, face-to-face counseling sessions.

Surgery, once the last-gasp choice of the desperate, is now recommended for patients with a BMI of 40 or greater or a BMI of 35 and two other risk factors for heart disease.

These guidelines, and others like them, came from the American Heart Association, the American College of Cardiology and the Obesity Society.

There will be plenty of these doctor-patient conversations in Marion County, where 32 percent of adults were listed as obese in 2012. That compares with 19 percent overall for Florida, according to the latest report from the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.

Pediatricians are in on the act, as well. More than 46 percent of public school students in first, third and fifth grades are overweight or obese, according to the latest review from the Florida Department of Health in Marion County.

The proactive approach is a comfortable one for Dr. James F. London, who practices at Ocala Family Medical Center. He has seen a dramatic increase in patients who have, or are close to developing, metabolic syndrome, which is a group of factors that raises the risk of developing heart disease, diabetes and stroke.

“Unfortunately, we don't have a magic pill” to eliminate problems related to weight, lipid levels and high blood pressure, said London, who is board certified in internal medicine, cardiology and nuclear cardiology.

What medical professionals do have is the power of persistence.

Some patients hear what the doctor says and respond with behavior modification. Others don't.

“You just have to keep working at it,” London said.

London doesn't just talk the talk. He literally walks the walk.

Several years ago, London started a local version of the “Walk With A Doc” program. On Saturday mornings, he or another staff member leads an exercise walk for patients from the practice building to a nearby park.

“I didn't think they (the walks) would last,” said Larry Mayfield, the practice CEO.

But they have, and they are well attended.

“I can feel that there is a trend toward people being more active,” said London, who has been in the Ocala area for five years or so.

Todd R. Panzer, a certified advanced registered nurse practitioner at Ocala Family, said the patient-care provider relationship is critical. Trust is earned, and patients respond to activities like the Saturday morning walks and the practice's well-attended education seminars.

“We're trying to make sure we maintain that” rapport, Panzer said.

That's also part of the reason Ocala Family sponsors youth sports teams and conducts athletes' physicals.

“You can tell people things all day long,” Panzer said. But you also have to play some offense and help them along in their exercise efforts, both in a clinical setting and in a broader context.

Although this new set of guidelines came out last month, the insurance wing of the health care industry already has been moving in that direction.

Mayfield notes that last year Medicare started covering behavioral counseling for obese patients. According to USA Today, the new Affordable Care Act will require most private insurers to cover such counseling and related treatments in 2014.

Dr. John Nardandrea practices at Family Care Specialists, which is part of the Ocala Health family. He said just this year insurance providers started requiring providers to include patients' BMI readings in their assessments.

Failure to list that metric would be akin to leaving out the patient's blood pressure reading — and perhaps complicate the practice's efforts to be reimbursed for care.

Nardandrea, like London, has long been addressing his patients' weight and related issues. “I'm pretty aggressive about that,” he said.

Nardandrea's approach: “Always empower the individual first.”

In other words, don't just encourage good diet and regular exercise. Add to that by recommending plans (such as the South Beach Diet) or books (like “Younger Next Year.”)

In other circumstances, referrals to clinics, dieticians or commercial programs like Weight Watchers might be appropriate.

“I don't give up easily,” Nardandrea said, though he acknowledges some longtime patients might not budge even after repeated pushing.

Nardandrea, who is board certified in family practice and hospice/palliative care, said it's important to set realistic goals. Even if a patient can't lose all his or her excess weight, consistently dropping 2 or 3 pounds a month is a move in the right direction and will lead to measurable health improvements.

Debbie Kemp, 47, is one of those people who help others meet fitness goals — whether modest or ambitious. She is group exercise manager at Brick City Health and Fitness and on any given day, for personal or professional purposes, can be found engaging in cross-fit, spin, Pilates and interval training.

Due to her career and healthy lifestyle, her weight has not been questioned by any doctors. But not everyone is as fortunate.

Dr. Eric I. Rosenberg, chief of internal medicine at the University of Florida College of Medicine in Gainesville, approaches the issues from two vantage points: clinician and educator.

As a physician who is board certified in internal medicine and sees patients in clinic, Rosenberg said the new guidelines are “music to our (providers') ears.”

Even when patients know they are overweight it can be difficult to take that next step. The patient might be embarrassed; the clinician might be wary of giving offense.

But now, with the issue a hot topic in the news, the barriers might be lowered. “I think this helps,” Rosenberg said.

Health care providers know it's important to address patients' weight, not just the consequences, such as high blood pressure. Once clinician and patient can get to the next step, progress is possible.

Providers can engage in “motivational interviewing.” It starts with a discussion (How have past weight-loss efforts gone? What are the barriers to success?) and progresses to goal setting and planning — everything from diet and exercise modification to surgery, in the extreme cases.

Rosenberg also is an associate professor of medicine at UF and teaches medical students in residency. So he is training the next generation of doctors to address patients' weight issues.

He said it's important for students to see success stories, where patients have lost weight and improved their health — just as people have stopped smoking and experienced health benefits.

Persistence is key, Rosenberg said, and barriers like the patient's potential embarrassment or trepidation can, and must, be worked around.

“Be their ally, not their judge,” he said.

Andrew Harrison, 20, of Ocala, works out four to six days each week, mostly by lifting weights. The University of Central Florida student said his doctor told him he was over his recommended weight, but only because of muscle mass.

Harrison said it's a good idea for doctors to take a proactive approach on obesity because it is such a rapidly growing problem.

“Most doctors approach the topic very gingerly, like they are scared; in fact, I think it is wrong that they tiptoe around the topic so much because it is their job to be concerned about their patients' health,” Harrison said.

Rich Offenberg, a 55-year-old account executive, said he never works out. He has an annual physical but has never been presented with a question about his weight.

“When you go for an annual physical, in a sense, that is a proactive visit. And if you are overweight based on your height and age, it would be a great practice to discuss health concerns that could be attributed to your weight,” Offenberg said.

“If you have no current issues that might be due to weight — however, you are (still) overweight — the physician should discuss potential health issues that might arise if you do not lose weight or continue to gain weight,” he said.

Correspondent Samantha Stathas contributed to this report. Contact Jim Ross at 671-6412 or jim.ross@ocala.com. Follow him on Twitter @jimross96.

<p>On Thanksgiving morning, more than 1,000 runners put on long-sleeved shirts, braved the chill and competed in the annual 5K Turkey Trot.</p><p>Hours later, many of those athletes traded their race-day bibs for dinner bibs and trotted toward a dining room table.</p><p>Exercise, then eat. Seems like a fair trade. And for that one day, perhaps it was — provided the pumpkin pie slices were of defensible dimensions.</p><p>But statistics suggest many Marion County residents are eating more than exercising on the 364 other days of the year. And while talking about weight management during the holiday season might be a bah-humbug kind of thing to do, the timing actually is just right. Because in 2014, the medical profession will be zeroing in on patients' weight like never before.</p><p>In mid-November, national medical experts issued a new, headline-grabbing set of guidelines concerning heart health and proper use of cholesterol-lowering statins.</p><p>The general idea was that patients' heart risk should be assessed in a more broad fashion, not just by their cholesterol numbers, and that medical providers should be more aggressive in getting patients on medicinal regimens.</p><p>Less noticed, but equally significant, was a related set of guidelines for combating and addressing obesity. In essence, the rules call for a more aggressive approach to identifying and addressing weight problems.</p><p>In other words, at your next annual checkup in 2014, the doctor is less likely to say, “Hey, you could afford to lose some weight,” and leave it at that.</p><p>Rather, doctors are now asked to, at least once a year, calculate their patients' body-mass index (BMI) and measure their waists. If appropriate, doctors are advised to develop a weight-loss plan that includes dietary and exercise components and, perhaps, face-to-face counseling sessions.</p><p>Surgery, once the last-gasp choice of the desperate, is now recommended for patients with a BMI of 40 or greater or a BMI of 35 and two other risk factors for heart disease.</p><p>These guidelines, and others like them, came from the American Heart Association, the American College of Cardiology and the Obesity Society.</p><p>There will be plenty of these doctor-patient conversations in Marion County, where 32 percent of adults were listed as obese in 2012. That compares with 19 percent overall for Florida, according to the latest report from the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.</p><p>Pediatricians are in on the act, as well. More than 46 percent of public school students in first, third and fifth grades are overweight or obese, according to the latest review from the Florida Department of Health in Marion County.</p><p>The proactive approach is a comfortable one for Dr. James F. London, who practices at Ocala Family Medical Center. He has seen a dramatic increase in patients who have, or are close to developing, metabolic syndrome, which is a group of factors that raises the risk of developing heart disease, diabetes and stroke.</p><p>“Unfortunately, we don't have a magic pill” to eliminate problems related to weight, lipid levels and high blood pressure, said London, who is board certified in internal medicine, cardiology and nuclear cardiology.</p><p>What medical professionals do have is the power of persistence.</p><p>Some patients hear what the doctor says and respond with behavior modification. Others don't.</p><p>“You just have to keep working at it,” London said.</p><p>London doesn't just talk the talk. He literally walks the walk.</p><p>Several years ago, London started a local version of the “Walk With A Doc” program. On Saturday mornings, he or another staff member leads an exercise walk for patients from the practice building to a nearby park.</p><p>“I didn't think they (the walks) would last,” said Larry Mayfield, the practice CEO.</p><p>But they have, and they are well attended.</p><p>“I can feel that there is a trend toward people being more active,” said London, who has been in the Ocala area for five years or so.</p><p>Todd R. Panzer, a certified advanced registered nurse practitioner at Ocala Family, said the patient-care provider relationship is critical. Trust is earned, and patients respond to activities like the Saturday morning walks and the practice's well-attended education seminars.</p><p>“We're trying to make sure we maintain that” rapport, Panzer said.</p><p>That's also part of the reason Ocala Family sponsors youth sports teams and conducts athletes' physicals.</p><p>“You can tell people things all day long,” Panzer said. But you also have to play some offense and help them along in their exercise efforts, both in a clinical setting and in a broader context.</p><p>Although this new set of guidelines came out last month, the insurance wing of the health care industry already has been moving in that direction.</p><p>Mayfield notes that last year Medicare started covering behavioral counseling for obese patients. According to USA Today, the new Affordable Care Act will require most private insurers to cover such counseling and related treatments in 2014.</p><p>Dr. John Nardandrea practices at Family Care Specialists, which is part of the Ocala Health family. He said just this year insurance providers started requiring providers to include patients' BMI readings in their assessments.</p><p>Failure to list that metric would be akin to leaving out the patient's blood pressure reading — and perhaps complicate the practice's efforts to be reimbursed for care.</p><p>Nardandrea, like London, has long been addressing his patients' weight and related issues. “I'm pretty aggressive about that,” he said.</p><p>Nardandrea's approach: “Always empower the individual first.”</p><p>In other words, don't just encourage good diet and regular exercise. Add to that by recommending plans (such as the South Beach Diet) or books (like “Younger Next Year.”)</p><p>In other circumstances, referrals to clinics, dieticians or commercial programs like Weight Watchers might be appropriate.</p><p>“I don't give up easily,” Nardandrea said, though he acknowledges some longtime patients might not budge even after repeated pushing.</p><p>Nardandrea, who is board certified in family practice and hospice/palliative care, said it's important to set realistic goals. Even if a patient can't lose all his or her excess weight, consistently dropping 2 or 3 pounds a month is a move in the right direction and will lead to measurable health improvements.</p><p>Debbie Kemp, 47, is one of those people who help others meet fitness goals — whether modest or ambitious. She is group exercise manager at Brick City Health and Fitness and on any given day, for personal or professional purposes, can be found engaging in cross-fit, spin, Pilates and interval training.</p><p>Due to her career and healthy lifestyle, her weight has not been questioned by any doctors. But not everyone is as fortunate.</p><p>“Yes, they (health care professionals) need to address the fact of healthy eating and exercise versus diet alone, or weight-loss medications or surgeries,” Kemp said.</p><p>Dr. Eric I. Rosenberg, chief of internal medicine at the University of Florida College of Medicine in Gainesville, approaches the issues from two vantage points: clinician and educator.</p><p>As a physician who is board certified in internal medicine and sees patients in clinic, Rosenberg said the new guidelines are “music to our (providers') ears.”</p><p>Even when patients know they are overweight it can be difficult to take that next step. The patient might be embarrassed; the clinician might be wary of giving offense.</p><p>But now, with the issue a hot topic in the news, the barriers might be lowered. “I think this helps,” Rosenberg said.</p><p>Health care providers know it's important to address patients' weight, not just the consequences, such as high blood pressure. Once clinician and patient can get to the next step, progress is possible.</p><p>Providers can engage in “motivational interviewing.” It starts with a discussion (How have past weight-loss efforts gone? What are the barriers to success?) and progresses to goal setting and planning — everything from diet and exercise modification to surgery, in the extreme cases.</p><p>Rosenberg also is an associate professor of medicine at UF and teaches medical students in residency. So he is training the next generation of doctors to address patients' weight issues.</p><p>He said it's important for students to see success stories, where patients have lost weight and improved their health — just as people have stopped smoking and experienced health benefits.</p><p>Persistence is key, Rosenberg said, and barriers like the patient's potential embarrassment or trepidation can, and must, be worked around.</p><p>“Be their ally, not their judge,” he said.</p><p>Andrew Harrison, 20, of Ocala, works out four to six days each week, mostly by lifting weights. The University of Central Florida student said his doctor told him he was over his recommended weight, but only because of muscle mass.</p><p>Harrison said it's a good idea for doctors to take a proactive approach on obesity because it is such a rapidly growing problem.</p><p>“Most doctors approach the topic very gingerly, like they are scared; in fact, I think it is wrong that they tiptoe around the topic so much because it is their job to be concerned about their patients' health,” Harrison said.</p><p>Rich Offenberg, a 55-year-old account executive, said he never works out. He has an annual physical but has never been presented with a question about his weight.</p><p>“When you go for an annual physical, in a sense, that is a proactive visit. And if you are overweight based on your height and age, it would be a great practice to discuss health concerns that could be attributed to your weight,” Offenberg said.</p><p>“If you have no current issues that might be due to weight — however, you are (still) overweight — the physician should discuss potential health issues that might arise if you do not lose weight or continue to gain weight,” he said.</p><p><i>Correspondent Samantha Stathas contributed to this report. Contact Jim Ross at 671-6412 or jim.ross@ocala.com. Follow him on Twitter @jimross96.</i></p>